Change In Physical Component Summary Research Articles

Submacular surgery trials randomized pilot trial of laser photocoagulation versus surgery for recurrent choroidal neovascularization secondary to age-related macular degeneration: ii. quality of life outcomes submacular surgery trials pilot study report number 2

PURPOSE: To summarize findings from health-related quality-of-life interviews with patients who had recurrent subfoveal choroidal neovascularization secondary to age-related macular degeneration and participated in a randomized pilot trial (focal confluent laser photocoagulation versus submacular surgery) that may assist in planning future assessments of health-related quality of life in patients with age-related macular degeneration. PATIENTS AND METHODS: Of 70 patients enrolled in the pilot trial, 54 were interviewed before random assignment to treatment and provided the data analyzed for this report. Patients were scheduled for follow-up interviews at 6, 12, and 24 months after enrollment. The 36-Item Short-Form Health Survey was used in all cases and was administered by an interviewer. The summary scales, Physical Component Summary and Mental Component Summary, were the focus of this analysis. RESULTS: Median Physical Component Summary and Mental Component Summary score at baseline were 47 and 53, respectively. Distributions of scores at baseline and throughout the 2-year follow-up period were similar in the two treatment arms and consistent with those of a sample of the general US population of similar age. Distributions of both Physical Component Summary scores and Mental Component Summary scores for individual patient subgroups at baseline suggested sensitivity to some measures of baseline vision. During 2 years of follow-up interviews, median changes in Physical Component Summary scores were decreases of six points in the laser arm and three points in the surgery arm; in both treatment arms, median change in Mental Component Summary scores was an increase of 2 points. Two-year changes in visual acuity had no discernible effect on Physical Component Summary scores or Mental Component Summary scores; baseline scores were the strongest predictors of 2-year changes in Physical Component Summary and Mental Component Summary scores. CONCLUSIONS: Overall, summary scores from the 36-Item Short-Form Health Survey and changes in scores over 2 years in this pilot trial were consistent with the ophthalmic outcome measures (reported elsewhere) that showed no important differences between the treatment arms. These health-related quality-of-life findings provided assurance that the similarity of ophthalmic outcomes in the two treatment arms did not mask changes potentially important to patients that were not captured as part of the clinical outcome data.

HEALTH-RELATED QUALITY OF LIFE IN 561 VETERANS WITH COMORBID MEDICAL AND PSYCHIATRIC CONDITIONS DURING 6- AND 12-MONTH FOLLOW UP

Objectives: The following report investigates the relationships between the change in health-related quality of life, defined as change in the Medical Outcomes Study Short Form 36- Item Health Survey (SF-36) subscale and composite scores, and change in severity of symptoms of depression, anxiety, and alcohol abuse over time in patients with comorbid medical and psychiatric illnesses. Methods: Patients admitted to acute medical and surgical services of 9 VA Medical Centers were screened for symptoms of depression, anxiety and alcohol abuse, and re-examined 6- and 12-months later. Each site randomized eligible geriatric veteran inpatients to either the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) or Usual Care modalities. Screening instruments were also used as outcome measures at follow up, and included 1) SF-36; 2) Mental Health Index (MHI-38) with Depression and Anxiety subscales; 3) Alcohol Use Disorders Index (AUDIT). Eight SF-36 subscale scores and the Mental Component Summary (MCS) and Physical Component Summary (PCS) scores were obtained according to the SF-36 Manual guidelines. Change in psychiatric symptoms and health-related quality of life over time was analyzed by repeated measures MANOVA. Demographic characteristics of the UPBEAT and Usual Care groups were compared by ANOVA and chi-square analyses. The relationship between health related quality of life and change in severity of psychiatric symptoms over time was analyzed by MANCOVA and correlation analyses. Results: To-date, 561 patients completed 6- and 12- month follow up, 542 men (96%) and 19 women (4%), mean age 69.4 (SD=6.2). Of these patients, 84% screened in for depression and 66% for anxiety. At this time, we found no significant differences between patients assigned to UPBEAT and to Usual Care with respect to change in psychiatric symptoms and SF-36 subscale and composite scores over time. Therefore, groups were combined for subsequent analyses. Patients demonstrated improvement on MCS score at 6 and 12 months when compared to baseline and all but one subscales of the SF-36 (Physical Functioning). They did not show a significant change in the PCS score. They also demonstrated improvement in the severity of depression, anxiety, and alcohol abuse over time. Improvement on MCS correlated with improvement in the severity of depression and anxiety, but not alcohol abuse. The degree of improvement in MCS was greatest in the most severely depressed individuals. Unemployment and income lower than $10,000/year were associated with improvement in MCS over time. Marital status, race, sex, religion were not associated with change in MCS or PCS over time. Significance: MCS, but not PCS, demonstrated change over time. The improvement in MCS in the elderly patients with comorbid medical and psychiatric conditions may occur in association with reduction in the severity of their psychiatric symptoms even in presence of unchanged PCS. Sociodemographic variables may contribute to change in the MCS.